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This paper uses data from a nationwide Swedish health insurance society (1912–1914) to explore how gendered rural and urban living conditions shaped morbidity during a period characterized by the epidemiological transition and an urban penalty in mortality. Infectious diseases were more common in rural areas, driving the urban–rural morbidity gap. Urban regions experienced less sickness episodes due to lower fertility and pregnancy-related illnesses among women and safer workplaces for men. The findings suggest that urban areas led the epidemiological transition, with urban populations benefiting from more favorable living conditions, while rural populations experienced a rural penalty in morbidity.

The common narrative about historical health insurance societies emphasizes that they compensated the male breadwinner’s lost income. However, this fails to explain the relatively high and increasing share of female members, including unpaid domestic workers, in Swedish health insurance societies during the early twentieth century. To amend this lack of explanation, this paper investigates the rationale for women’s enrollment in health insurance societies in early twentieth-century Sweden. It explores the impact of factors relating to the labor market and health insurance supply, and the impact of members’ individual characteristics. Additionally, the study analyzes how female-specific morbidity and pregnancy-related illness, alongside the incapacity to perform domestic chores, influenced women’s decisions to acquire health insurance. Findings indicate clear regional differences and two mechanisms of enrollment, applying to primarily unmarried gainfully employed women and primarily married unpaid domestic workers, respectively. Hence, health insurance compensated for lost wage incomes for some and protected against the general loss of work capacity for most. Swedish health insurance societies appear to have recognized the necessity of women’s paid and unpaid work, and particularly the introduction of maternity insurance met demands for covering the costs associated with the inability of women to work both in the labor market and domestically.

Membership in mutual health insurance societies spread among industrial workers in the late nineteenth century. We study determinants of such membership among male workers in Swedish manufacturing by using matched employer–employee data from three industries covering all workers (i.e. members and non-members, N > 12 000) and firms around 1900. We find remarkably high rates of membership overall, and especially among married workers. The association between marital status and health insurance suggests that selection into health insurance societies was ‘propitious’ rather than ‘adverse’. Many workers became members well before the age of 40 years, when their health began to deteriorate, and this coincided with the average age of first marriage for men, occurring in their late twenties. Being married and having membership was more marked in firms with voluntary membership and was important for the viability of the mix of voluntary and compulsory health insurance societies emerging in Nordic countries around 1900. Findings support the idea that health insurance can attract high levels of membership under voluntary schemes and suggest why it took so long before statutory health insurance covering sickness absence and workplace accidents was introduced in Sweden.

In 2020, The COVID-19 crisis has put great pressure on the economy worldwide. Only time can tell whether the COVID-19 crisis will have permanent effects on corporate and household behaviour and how it will affect society at large. This article examines historical experiences of how households managed the financial consequences of rising mortality during the 1918 influenza pandemic. We find that the previous pandemic led to an immediate and major increase in primarily small-sum industrial life insurance policies designed for blue-collar workers. The increase in new policies did not, however, have a lasting effect. By the time the pandemic had faded, the number of policies had dropped to below pre-pandemic conditions. This historical experience underlines the fact that there are limits to the extent to which even a major shock, such as a pandemic, can lead to behavioural change among households as currently being predicted in relation to COVID-19.

This paper investigates gendered morbidity patterns by employing micro data derived from sickness records and membership ledgers on working class men and women in the early 20th century Sweden. We find that the main reason for gendered morbidity differences - that woman faced fewer, but longer sickness episodes than men – reflects gendered productive and reproductive activities. Men suffered from the large number of work-place accidents as workers in the production sector, while women faced major risks due to pregnancy, childbearing and related sickness. Women also suffered more from for diseases of the blood, diseases of the digestive & metabolic system and diseases the genitourinary than men. Both men and women faced shorter, but longer, sickness episodes in urban areas attributed to the underlying differences in morbidity causes during the epidemiological transition.

Mutual benefit societies evolved as the major provider for sickness, accident and life insurance in the late nineteenth and early twentieth centuries on both sides of the Atlantic. One of the major problems facing insurers was the risk of adverse selection, i.e. that unhealthy individuals had more incentives than healthy individuals to insure when priced for the average risk. By empirically examining whether longevity among insured individuals in a nationwide mutual health society was different from a matched sample of uninsured individuals, we seek to identify the presence of adverse selection. We find no compelling evidence showing that unhealthy individuals were more likely to insure, or reasons to believe that problems related to adverse selection would have been a major reason for government intervention in the health insurance market in Sweden.

Welfare researchers have regarded statutory accident insurance in 1916 as a starting point for the exceptional expansion of the Swedish welfare state. However, rather less attention has been paid to the roles played by mutual insurance societies and employer compensation schemes in offering voluntary welfare protection. We argue that voluntary welfare protection was an integral part of the early-twentieth century welfare system and played a crucial role in protecting workers in the case of sickness and accident. We also examine the limitations of these arrangements and explore the ways in which the design of the statutory scheme ensured that there was a continuing role for voluntary provision after the new Act came into operation. We also explore the impact of the scheme on wage levels, and show how its introduction eroded the wage premiums which had previously been earned by workers in high-risk industries.

Historical studies on the institutionalization of the mentally ill have primarily relied on data for institutionalized patients rather than the population at risk. Consequently, the underlying factors of institutionalization are unclear. Using Swedish longitudinal microdata from 1900–59 reporting mental disorders, we examine whether supply factors, such as distance to institutions and number of asylum beds, influenced the risk of institutionalization, in addition to demand factors such as access to family. Institutionalization risks were associated with the supply of beds and proximity to an asylum, but also dependent on families’ unmet demand for care of relatives. As the supply of mental care met this family-driven demand in the 1930s, the relative risk of institutionalization increased among those lacking family networks.

During the industrialization period, the rate of workplace-related accidents increased. Because of the lack of public insurance, mutual health insurance societies became the main providers of workplace accident insurance among workers. Due to large differences in accident risk, health insurance societies were potentially exposed to the risk of adverse selection, since they employed equal pricing for all members regardless of risk profile. This article investigates the impact of workplace accident risk on health insurance selection and outcomes. We employ household budget surveys encompassing urban workers in Sweden during the early twentieth century. We find evidence for a redistribution from low- to high-risk-exposed workers, as workplace accident risk had a significant and positive impact on receiving health insurance benefits, also when controlling for a variety of factors. Workers exposed to greater risks in the workplace were more likely to have health insurance but did not pay higher premiums. The redistribution from low- to high-risk-exposed workers was largely accepted and viewed as an act of solidarity between workers. Given that health insurance societies were aware of this redistribution, we argue for the presence of informed, rather than adverse, selection.

Mutual benefit societies evolved as the major provider for illness, accident and burialinsurance in the late 19 th and early 20 th century in the Western world. One of themajor problems facing the insurers was the risk for adverse selection; that unhealthyindividuals had more incentive then healthy to insure when priced for the averagerisk. By empirically examine if the longevity among insured in mutual benefit societieswas different from uninsured, we seek to identify the presence of adverse section. Wefind no compelling evidence that unhealthy individuals was more likely to insure, orreasons to believe that adverse selection was behind the decline of mutual benefitsocieties in the twentieth century.